title: Areca nut chewing and risk of atrial fibrillation in Taiwanese men: a nationwide ecological study.
abstract: BACKGROUND
  Areca nut chewing is associated with the risk of obesity, metabolic syndrome, hypertension, and cardiovascular mortality. Although a few case reports or case series have suggested the link between areca nut chewing and cardiac arrhythmias, information about the relationship between areca nut chewing and atrial fibrillation (AF) is lacking. Thus, a nationwide ecological study was conducted to investigate this.
  
  
  METHODS
  Two national datasets, the nationwide population-based 2005 Taiwan National Health Insurance Research dataset (NHIRD) and the 2005 National Health Interview Survey (NHIS), were used for analyses. The clinical characteristics, inhabited area and medical histories for 375,360 eligible males were retrieved from the 2005 NHIRD. Health related behaviors including areca nut chewing, cigarette smoking, infrequent vegetable eating, and exercise habit were collected from the 2005 NHIS. The prevalence of AF and the areca nut chewing rate were evaluated by multivariate analysis.
  
  
  RESULTS
  Of the 375,360 males (mean age, 44 years old), 1,326 (0.35%) were diagnosed with AF. The higher areca nut chewing rate, the higher prevalence rate of AF in Taiwan (Spearman correlation coefficient r=0.558, p=0.007). After adjusting for other covariates, the current areca nut chewing rate was found to be independently associated with the prevalence of AF. The adjusted odd ratio for areca nut chewing was 1.02 (95% CI=1.00-1.04) in risk of AF prevalence.
  
  
  CONCLUSIONS
  Areca nut chewing is independently associated with the prevalence of AF in Taiwanese men. However, further exploration of the underlying mechanisms is necessary.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Wei-Chung
authors.initials: WC
authors.lastname: Tsai
authors.forename: Chung-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Hsuan-Fu
authors.initials: HF
authors.lastname: Kuo
authors.forename: Ming-Tsang
authors.initials: MT
authors.lastname: Wu
authors.forename: Wei-Hua
authors.initials: WH
authors.lastname: Tang
authors.forename: Chih-Sheng
authors.initials: CS
authors.lastname: Chu
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Lin
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
authors.forename: Po-Chao
authors.initials: PC
authors.lastname: Hsu
authors.forename: Shih-Jie
authors.initials: SJ
authors.lastname: Jhuo
authors.forename: Ming-Yen
authors.initials: MY
authors.lastname: Lin
authors.forename: Kun-Tai
authors.initials: KT
authors.lastname: Lee
authors.forename: Sheng-Hsiung
authors.initials: SH
authors.lastname: Sheu
authors.forename: Wen-Ter
authors.initials: WT
authors.lastname: Lai
mesh_terms: D000328:Adult; D001114:Areca; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
keywords: areca nut chewing.; atrial fibrillation